Provider Demographics
NPI:1205088986
Name:JUNIPER VILLAGE EVENTIDE LP
Entity type:Organization
Organization Name:JUNIPER VILLAGE EVENTIDE LP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:PEPPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-542-3121
Mailing Address - Street 1:4920 VICEROY CT
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-9048
Mailing Address - Country:US
Mailing Address - Phone:239-542-3121
Mailing Address - Fax:
Practice Address - Street 1:4920 VICEROY CT
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-9048
Practice Address - Country:US
Practice Address - Phone:239-542-3121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JUNIPER COMMUNITIES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-14
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0007753310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility